Summary :
Objective: The aim of this study was to analyze the mana­ge­ment of free-flap failures in head and neck reconstructive surgery. Material and methods: All patients who experienced a free-flap failure in head and neck reconstructive surgery in our institution between 2000 and 2014 were included in this retrospective study. Results: A total of 51 free-flap failures (among 547 free flaps, 9.3%) were found during this period. They were 34 men and 17 women (mean age: 63.9 years). In 3 cases, a cause of failure was precisely identified (arterial spasm, protein S deficiency and atherosclerotic occlusion of peroneal artery). A second free flap was performed in 19 cases (37.3%) and a thoracic pedicled musculocutaneous flap was performed in 26 cases. A second free flap was performed for velar reconstruction in 8/8 cases, for mandibular symphyseal reconstruction in 4/5 cases and for pharyngeal reconstruction after circular total pharyngolaryngectomy in 4/7 cases. There were 2 failures among the 19 free flaps used for secondary recons­truction (10.5%). Conclusion: After a free flap failure, the choice of the secondary method of reconstruction depends on the identification of the causes of free-flap failure and their reversibility, the local and general conditions of the patient, as well as the predictable benefit of the use of a second free flap.